Cancer Patients in the Emergency Department: A “Nightmare” that Might Become a Virtuous Clinical Pathway

Legramante, Jacopo M.; Pellicori, Stefania; Magrini, Andrea; Frittelli, Tiziana; Formica, Vincenzo; Roselli, Mario

doi:10.21873/anticanres.12998

Cited by 13 publications

(7 citation statements)

References 5 publications

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“…Research demonstrates that cancer-specific pathways in general within an ED triage system can improve outcomes in terms of inpatient admission, decreased ED visits, and decreased overall mortality. [27][28][29] Given the variable outcomes among different cancer subtypes our study underscores importance of considering cancer type in the risk stratification process of this uniquely vulnerable patient population.…”

Section: Discussionmentioning

confidence: 89%

Impact of underlying malignancy on emergency department utilization and outcomes

et al. 2021

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Cancer patients frequently utilize the emergency department (ED) for a variety of diagnoses both related to and unrelated to their cancer, yet ED outcomes for cancer patients are not well documented. This study sought to define risks and identify predictors for inpatient admission and hospital mortality among cancer patients presenting to the ED. Patients and Methods:We utilized the National Emergency Department Sample to identify patients with and without a diagnosis of cancer presenting to the ED between January 2016 and December 2018. We used multivariable mixedeffects logistic regression models to assess the influence of cancer on outcomes of hospital admission after the ED visit and hospital mortality for the whole patient cohort and individual presenting diagnoses.Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) were associated with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). For each of the top 15 presenting diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2) or death (OR range 2.1-14.4). Although our dataset does not contain reliable estimation of stage, cancer site was the most robust individual predictor associated with the risk of hospitalization or death compared to other clinical or system-related factors.Conclusions: Cancer patients in the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions to improve outcomes.

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Section: Discussionmentioning

confidence: 89%

Impact of underlying malignancy on emergency department utilization and outcomes

et al. 2021

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“…Universally, pain remains a dominant reason for emergency service usage among cancer patients [ 12 ], as well as a significant predictor for hospital readmission and mortality [ 13 ]. The management of cancer patients admitted to emergency services in dedicated oncology pathways has been shown to improve health care [ 14 ]. Moreover, a large population-based projection study showed that by 2060, cancer patients will die of unnecessary health related suffering unless an expansion of palliative care is integrated into cancer programs [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Approach to Cancer Pain Management in Emergency Departments: Comparison of General and Oncology Based Settings

et al. 2022

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Cancer-related pain constitutes a dominant reason for admission to emergency services, and a significant patient and healthcare challenge. Evidence points to the rising prevalence of opioid misuse in this patient group. We sought to compare drug delivery in an oncology-dedicated emergency department (OED) and a general emergency department (GED) within the same hospital. As such, we obtained patient and drug-related data for OED and GED during a designated three-month period, and compared them using Fisher’s exact test, chi-square tests and the Mann-Whitney test. In total, 584 patients had 922 visits to emergency services (OED n = 479; GED n = 443), and were given 1478 drugs (OED n = 557; GED n = 921). Pain was a prominent chief complaint among visitors to the OED (17%) and GED (21%). Approximately a fifth of all drugs used were analgesics (OED—18.5%; GED—20.4%), however, in the GED, 51.6% (n = 97) were used for non-pain-related admissions, compared with 33.0% (n = 34) in OED. Opioid usage significantly differed between emergency settings. The GED administered three times as many intravenous opioids (p <0.001), a narrower spectrum of oral and intravenous drugs (p = 0.003) and no rapid-acting opioids, significantly fewer pain adjuvants (10.9% versus 18.7%, p < 0.001), and, finally, non-guideline-recommended drugs for pain, such as meperidine and benzodiazepines. Taken together, compared with the GED, the management of cancer-related pain in the OED was more personalized, and characterized by fewer intravenous opioids, enhanced diversity in drug type, route and method of delivery. Efforts should be directed toward reduction of disparities in the treatment of cancer pain in emergency settings.

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“…Thus, emergency physicians should be trained with a specific curriculum during their university course work focusing on acute care of cancer patients [16]. Some authors evaluated the benefit of embedding an oncologist in the ED with discordant results on patients' admission rates [17,18]. We think that acute complications of cancer patients need to be dealt with an emergency physicians in the same way as any other acute complications of another chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Cancer Patients’ Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER

Peyrony

Fontaine

Trabattoni

et al. 2021

JCM

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Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.

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Cancer Patients in the Emergency Department: A “Nightmare” that Might Become a Virtuous Clinical Pathway

Cited by 13 publications

References 5 publications

Impact of underlying malignancy on emergency department utilization and outcomes

Impact of underlying malignancy on emergency department utilization and outcomes

Approach to Cancer Pain Management in Emergency Departments: Comparison of General and Oncology Based Settings

Cancer Patients’ Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER

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